File:Operative gynecology - (1906) (14596936107).jpg

Identifier: operativegynecol001kell (find matches)
Title: Operative gynecology :
Year: 1906 (1900s)
Authors: Kelly, Howard A. (Howard Atwood), 1858-1943
Subjects: Gynecology Gynecology Gynecologic Surgical Procedures
Publisher: New York and London : D. Appleton and company
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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serve to bring it forward to any marked extent. Fig. 42 shows the pelvic floor as seen through the superior strait when allthe viscera are removed. Note the relations of the three orifices of exit—thenrethra, the vagina, and the rectum—in the muscular diaphragm of the pelvicfloor, and the relation of these to their surrounding bony supports. The pelvisis funnel-shaped and the orifices disposed in the anterior portion; the urethraappears as a small slit surrounded by thick walls just under the pubic arch.The vagina has the characteristic shape of the letter H lying on its side, andappears embraced by the muscular fibers of the levator ani, which hold thelower part of the rectum forward. The puckered rectal opening is grasped in 76 TOPOGRAPHICAL AX ATOMY. a sling of muscular fibers from the anterior portion of the levator ani, and isattached posteriorly to the coccyx by a fibrous band. The levator ani arisesfrom the inner surface of the pubic rami and the slightly curved white line,
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I Border of great sciatic foramenObturator nerveFig. 42.—The Muscular Structures Forming the Floor and Lateral Walls of the Pelvis. which crosses the obturator internus and ends at the spine of the ischium be-hind. From this line of origin its fibers converge to form a muscular sling,attached to and embracing the lower end of the rectum, so directed as to pull COURSE OF THE INTERNAL PUDIC ARTERY. 77 the rectum upward and forward. The anterior thick bundles of fibers, arisingfrom the upper inner part of the pubic rami, serve to draw the lowTer part ofthe bowel well forward, and so act indirectly as closers of the vagina. Theaction of the posterior fibers is simply that of holding the bowel up. Thecoccygens, pyriformis, and psoas muscles are also well seen as described inFig. 39. Fig. 43 shows the exact course of the internal puclic artery as it arisesfrom the anterior branch of the internal iliac, passes out of the pelvis throughthe great sacro-sciatic foramen, and crosses the spine

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